Study: Doubling dialysis makes hearts healthier

[KarenInWA]

Study: Doubling dialysis makes hearts healthier


Dalysis patients who underwent sessions up to six times a week, instead of the conventional three, showed improvement in their heart condition and told researchers they felt better, a study found.

By Bloomberg News

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NEW YORK — Dialysis patients who underwent sessions up to six times a week, instead of the conventional three, showed improvement in their heart condition and told researchers they felt better, a study found.

More-frequent dialysis resulted in less damage to patients' left ventricular heart muscles, which tend to thicken and enlarge when there's too much fluid in the body, said Glenn Chertow, chief of nephrology at Stanford University School of Medicine in California. That should "translate into better heart function," he said.

About 400,000 Americans undergo dialysis, with the annual cost of treating end-stage kidney-disease sufferers reaching $75,000 to $100,000 per patient, Chertow said. The study was reported Saturday at the American Society of Nephrology meeting in Denver.

While adding more sessions helped patients feel better, it may prove to be a challenge for companies that provide dialysis services, said Alan Kliger, a clinical professor of medicine at Yale University in New Haven, Conn., and senior author of the study.

"Capacity would definitely be an issue," said Mike Klein, chief executive officer of Renal Advantage in Brentwood, Tenn. "It would require a change in the system when it came to reimbursement as well."

It's difficult to estimate the cost to make the transition, given uncertainties about what the new protocol would entail, he said. Switching more patients to home dialysis may be one alternative because the costs are less, with fewer facilities and personnel needed, Klein said.

There is a quality-of-life advantage with home dialysis because "everybody is more comfortable in their own home, no matter how nice a facility is," Yale's Kliger said.

Medicare, the federal insurance plan for those 65 and older and the disabled, is responsible for most of the national cost of end-stage kidney disease. For more than 40 years, patients suffering from advanced stages of kidney disease have received dialysis three times a week for 3 to 4 hours per session, Chertow said.

In the study, patients received more-frequent dialysis, for 2.5 hours per session. While the trial was too small to conclude that more is better, it suggests "our one-size-fits-all approach" needs to be reassessed, he said.

Physical changes in the heart were evaluated with magnetic-resonance imaging, which measured the size of the heart. The thickening of the heart muscle that many dialysis patients exhibit can lead to death, Chertow said.

The added dialysis also improved blood pressure and levels of phosphate in the blood, the study found. Among adverse outcomes was a rise in procedures to ensure vascular access.

The death rate among patients undergoing dialysis in general is from 18 to 20 percent. It has prompted doctors to call for studies, like Chertow's, to evaluate whether the treatment can be improved.

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